Thursday, October 3, 2013

BY JAY WEAVER

Christopher Gregory Wayne, an osteopathic physician charged with ripping off Medicare, will have to stay in a Miami federal detention center until his trial, a magistrate judge ruled Thursday.

Wayne, 53, arrested Monday, pleaded not guilty to a dozen charges of submitting bogus bills for physical therapy treatments, such as massages and electrical stimulations, at his former Miami clinic.

But at his bail hearing, federal prosecutor Eric Morales argued that Wayne filed almost $5 million in false claims for those treatments in 2007-09 and was paid $1.7 million by the taxpayer-funded Medicare program. He said Wayne, whose patients dubbed him the “Rock Doc” because of his punk-style hairdo, submitted bills for 500 daily physical therapy sessions on average in 2008 — a mathematical impossibility.

Some patients told the federal grand jury that his therapy services were a “joke,” the prosecutor said, adding that the treatments were sometimes provided by Wayne’s unlicensed “office girls.”

Morales told Magistrate Judge Barry Garber that Wayne faced between 6 1/2 and 8 years in prison, making him a likely risk of flight. He also pointed out that the physician filed for bankruptcy, his Miami Beach home was mortgaged to the hilt and that he traveled out of the country in recent years.

Wayne’s criminal defense attorney Michael Grieco countered his client was only charged with $230 in actual Medicare fraud — not millions. He also noted that Wayne has lived in Miami Beach for more than 20 years and has family in Arkansas and Illinois. And, he pointed out, the federal probation office recommended that Wayne get a personal surety bond before trial.

“He’s not going anywhere,” Grieco said.

But Garber, the magistrate, sided with the prosecutor, saying “he might well flee this jurisdiction.”

Wayne, who has sported punkish hair along with chains, bangles and leather bracelets in the past, has been in the public eye before as a focus of a Wall Street Journal profile in December 2010.

According to the profile, he had used his Pine Tree Island home as a production studio for Playboy photo spreads and had posed with celebrities such as Paris Hilton and Aerosmith’s Steven Tyler.

The Miami indictment charges him with 12 counts of Medicare fraud by submitting “false claims” for therapeutic treatments, such as a 15-minute massages ($25), electrical stimulations ($20) and ultrasounds ($15).

The indictment accuses him of “falsely and fraudulently representing that these treatments and services were medically necessary and had been provided to Medicare beneficiaries” between December 2007 and August 2009.

The indictment further alleges that he disbursed the Medicare payments to himself and others.

But Medicare administrators grew suspicious of Wayne’s voluminous billing activity for physical therapy services and began heavily scrutinizing his bills in 2009. That increased oversight forced him to sell his business.

Wayne, who obtained his osteopathic license in 1990, worked for a pain clinic, Park Place Medical Group, in Fort Lauderdale in 2010-11, according to state records.

But he got into trouble dispensing pain killers and other prescription drugs. In September 2012, the state Department of Health banned him from owning, operating or working in a pain management clinic and from dispensing prescription drugs, such as Oxycodone, Xanax and Flexeril.

His Facebook page says Wayne, who received his osteopathic degree from Nova Southeastern University, is now working in the emergency room at Larkin Community Hospital in South Miami. He was arrested there Monday by agents with the FBI and Department of Health and Human Services-Office of Inspector General.

Wayne also says he worked at Regional General Hospital in Williston, and as a family physician in Hialeah Gardens.

HIPAA: The basics

For those who may be unfamiliar, HIPAA (Health Insurance Portability and Accountability Act), refers to a set of laws passed in the United States in 1996. The laws seek to limit access to individually identifiable healthcare information to those that "need to know". HIPAA holds healthcare industry professionals accountable for the privacy of patient information.

Effective HIPAA compliance implementations resemble effective security systems: they're designed with the aim of protecting individually identifiable health information (IIHI). Such information is broadly referred to as "protected health information", or PHI. This information includes an individual's name, address, and any information related to the individual's health or payment records. A Business Associate Agreement (BAA) provides written assurances that an organization's partners will also seek to secure an individual's PHI.

Google Apps BAA

Google's BAA agreement covers three Google Apps services (Gmail, Calendar, and Drive), along with the Google Apps Vault service, which archives user data from the other three services. To sign up, an Administrator for the Google Apps domain must answer three questions online. From the website:

Are you a Covered Entity (or Business Associate of a Covered Entity) under HIPAA?

Will you be using Google Apps in connection with Protect Health Information?

Are you authorized to request and agree to a Business Associate Agreement with Google for your Google Apps domain?

After responding, the Administrator will be taken to the BAA document for signature. As of September 27, 2013, Google is using Adobe's Echosign to obtain digital signatures.

Read before signing

The BAA terms state "...other Google services or third party Marketplace Apps should not be used in connections with PHI. This agreement requires that you disable all Additional services in the Admin console." (Emphasis is mine.)

An organization signing the BAA would not be able to use the domain covered by this agreement for additional useful Google services, such as Google+, Google Groups, or Google Sites. As the terms state, you must disable all Additional services: you may use Gmail, Calendar, Drive and Google Vault. The terms also appear to prohibit the use of Marketplace Apps in conjunction with PHI. (It is unclear whether the terms also prohibit the use of apps intended to secure and protect PHI, such as zSentry. zSentry offers to sign a BAA, and is a third-party app, which may be connected through the Marketplace.)

Implement thoughtfully

If your organization needs HIPAA compliant email, calendars and document storage, then sign the BAA and move forward with the migration. Your organization can adopt Gmail, Calendar, and Drive, confident that IIHI and PHI in those apps will be protected by the BAA.

If your organization is already using Google Apps, review your usage carefully before signing the BAA. If you've already implemented measures to ensure HIPAA compliance, the availability of a BAA may not change anything for your organization. For example, you might already prohibit the use of PHI in Gmail, Calendar and Drive. You might already use tools to audit and verify compliance, such as CloudLock.

Documents don't ensure security

Google's willingness to sign a BAA for organizations that need to comply with HIPAA is helpful and certainly welcomed. It may remove a barrier to adoption for some organizations. But healthcare professionals need to remember that HIPAA compliance, like all IT security, involves complex systems comprised of people, policies, and practices. (For example, you still need effective password policies, security measures such as 2-step authentication, and appropriate user permission settings.)

Signing a BAA doesn't ensure your entire organization is HIPAA compliant: the BAA is just one piece of a complex system needed to protect IIHI and PHI.

DETROIT (WWJ) – An Oakland County doctor accused of intentionally misdiagnosing patients and ordering unnecessary treatments will remain in jail until trial.

Dr. Farid Fata asked a federal judge Wednesday to lower his bond from $9 million to $500,000.

But Judge Paul Borman instead ruled there would be no bond.

WWJ Legal Analyst Charlie Langton was in the court room when the decision was made.

“The judge cited that the doctor was a likely flight risk, that he has significant ties to Lebanon — he owns a house there, he recently visited there, and he’s got substantial family in Lebanon,” Langton reported. “Also, the doctor has the means to flee, having received nearly $169 million for Medicare.”

Prosecutors say they’re still not sure if they’ve found all his money.

Outside the courthouse, about a dozen people protested against Fata’s possible release. One sign read, “Without fail Fata will jump bail.”

Fata is charged with committing fraud to enrich himself through health insurance programs. The government says some patients were repeatedly exposed to powerful drugs despite having no cancer. Fata denies it.

Liz Lupo, whose mother was a patient of Dr. Fata, talked to reporters at the courthouse.

“I’m thrilled; we couldn’t have had a better outcome,” Lupo said. “I’m not a vengeful person. I’m not one of the people saying he should have chemo treatments like he gave his patients … But something has to be done.”

Thousands of retired state workers in the Springfield area would lose coverage from Health Alliance Medical Plans based on contract decisions announced by the state this week, but those retirees would be able to keep their Springfield Clinic doctors.

“Those members would still have a medical home at Springfield Clinic,” Mark Kuhn, chief administrative officer at the Springfield-based multi-specialty group, said Wednesday.

The Illinois Department of Central Management Services on Tuesday announced the selection of four contracts for Medicare Advantage plans that will serve 123,000 retirees statewide, most of them 65 or older.

The company is considering whether to appeal the decision within administrative channels, according to Health Alliance senior vice president Jane Hayes.

Health Alliance was “surprised and disappointed” by the state’s decision, she said. “We’re looking at our options.”

Health Alliance serves 15,000 Medicare-eligible state retirees affected by the new contracts. Several thousand of those retirees live in the Springfield area, and many of them use Springfield Clinic doctors through different contracts with the state.

Kuhn said those retirees will be able to continue with Springfield Clinic doctors because the clinic is part of the Humana and Aetna networks offered by companies that won contracts this week for coverage that begins Jan. 1.

The plans include a health-maintenance organization plan from Aetna Life Insurance Co., an HMO plan from Humana Health Plan, an HMO plan offered by Humana Benefit Plan, and a preferred-provider plan offered by UnitedHealthcare.

Currently, Medicare-eligible state retirees have about 80 percent of their health-care costs paid by the federal Medicare program. The remaining 20 percent is covered by one of the health insurance plans offered to active workers.

Offering this type of Medicare supplement coverage through standard insurance plans is costly, according to CMS officials who have said the state could save more than $100 million annually by switching these retirees to Medicare Advantage plans.

With Medicare Advantage, Medicare benefits are provided by a private insurance company rather than the federal government. The insurer receives a stipend from the federal government for providing the benefits.

Health Alliance’s exclusion from the state’s new Medicare Advantage contracts appears to be a more significant issue for patients in the Champaign-Urbana area. That’s because about 6,000 retirees in that area who receive their care through the Carle health system may have to change doctors.

The Carle doctors aren’t included in any of the Medicare Advantage networks of the companies awarded contracts, Hayes said.

Health Alliance’s Medicare plans have been rated among the top in the state by the National Committee for Quality Assurance, she said.

Innovation Health Insurance Company and Innovation Health Plan Inc. ("Innovation Health"), the result of a partnership between Aetna and Inova, have received approval from the Virginia Bureau of Insurance to begin offering health insurance and HMO plans to employer groups of two or more members.
Aetna and Inova announced their collaboration and the formation of Innovation Health in May 2012, joining forces in a new way to deliver and finance more affordable, quality health care for employers and residents in Northern Virginia.
"We're excited to bring Innovation Health products to the Northern Virginia marketplace. Our goal when we formed Innovation Health was to demonstrate that an insurance company and a health care system, working together, can dramatically improve the quality and delivery of patient care while also reducing the costs associated with that care," said Tom Grote, Aetna's president for Virginia, Maryland and Washington, D.C. "With these approvals, we're ready to take the next step."
Innovation Health will offer fully insured and self-insured group products beginning with effective dates of Oct. 1, 2013. Plans will be available to businesses whose employees primarily are located in Alexandria City, Arlington, Fairfax, Fairfax City, Falls Church City, Fredericksburg City, Loudoun, Manassas City, Manassas Park City, Prince William, Spotsylvania and Stafford. Innovation Health plans also will be offered to individuals both on and off Virginia's health care exchange. For more information, see www.innovation-health.com.
"These plans offer superior health care advantages, including clinical integration and a unique payer/provider collaboration," said Knox Singleton, CEO of Inova. "Coupled with a comprehensive network of community physicians, emphasis upon preventive care and, when required, treatment at the right facility at the right time, Northern Virginia consumers will enjoy lower costs and greater patient satisfaction."
The partnership combines long-standing local, regional and national experience to deliver sustainable solutions for high-quality, affordable health care. Innovation Health leverages Aetna and Inova services and technology to promote wellness and improve patient outcomes.
Inova serves more than 2 million people each year from throughout and beyond the Washington, D.C. metropolitan area. Aetna provides health benefits to more than 600,000 members in Virginia.About Aetna
Aetna is one of the nation's leading diversified health care benefits companies, serving an estimated 44 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology products and services. Aetna's customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.About Inova
Inova is a not-for-profit health care system based in Northern Virginia that consists of hospitals and other health services, including emergency- and urgent-care centers, home care, nursing homes, mental health and blood donor services, and wellness classes. Governed by a voluntary board of community members, Inova's mission is to improve the health of the diverse community it serves through excellence in patient care, education and research.